GLOBE AND MAIL

By Sean Rourke, Trevor Stratton, Notisha Massaquoi And Bill Flanagan

Today in Montreal, Canada’s political leaders are participating the AIDS 2022 conference, bringing the world together to accelerate the fight to end HIV and AIDS globally. Unless their words can be translated into political will and action, we will be no further ahead in ending HIV in Canada.

The number of new HIV cases in Canada has been on the rise over the past five years, and in 2020 (our most recent national estimates of HIV surveillance), four people were infected with HIV every day. However, this is likely an underestimate – we expect to see a higher rate of new HIV infections in 2021 and 2022 because COVID-19 significantly restricted access to HIV testing and treatment.

It is shameful that we are still not getting testing and treatment to those who need it most.

We are among the worst of the G7 countries in making significant progress in achieving the UNAIDS 95-95-95 targets of diagnosing 95 per cent of HIV cases, getting 95 per cent of those people on life-saving treatment, and getting the virus levels of 95 per cent of that group to “undetectable” levels so they can live healthy lives. Most concerning are recent numbers from 2020 that show women are doing worse than men overall in access to testing and treatment – and Indigenous Peoples (First Nations, Métis and Inuit), racialized communities, including African, Caribbean and Black people, and people who use substances and inject drugs, are doing the worst overall.

Having HIV is no longer a death sentence, but people who are infected need to be tested and have access to treatment that will suppress the virus. Unfortunately, one out of 10 people living with HIV is undiagnosed (they have HIV but don’t know it). That’s more than 6,500 people in Canada who are not able to benefit from antiviral treatment. If they don’t get access to testing and are not properly diagnosed, they will get very sick at some point and develop AIDS. And those undiagnosed and without their virus suppressed may also unknowingly infect others.

We have all of the tools and knowledge we need to correct these shortcomings.

In November 2020, we worked to get the first HIV self-test approved in Canada, and then research programs were developed and implemented to provide low barrier access to home testing using technology platforms. But our governments have yet to take up these successful initiatives and scale them sufficiently to reach all of those who are undiagnosed across Canada.

UNITY HEALTH TORONTO

June 1, 2022 — Throughout her nearly 29-year career in research and medicine, Dr. Janet Smylie has focused on addressing health inequities faced by Indigenous peoples in Canada. At its core, her work is about using knowledge to propel change through action.

“In the modern world, we can get away with a focus on knowing and knowledge but where I come from, as a Métis Cree woman and from an Indigenous knowledge perspective, the gap between knowing and doing doesn’t exist,” she says. “The key to reconciliation is bridging the gaps between what we know and what we do. It’s the key to life and to solving most problems.”

Now, the first Strategic Lead of Indigenous Wellness, Reconciliation and Partnerships at Unity Health, Dr. Smylie is bringing that focus into this new role. Over the next seven months, she’ll lead several projects that support Unity Health’s ongoing efforts to develop a strategy and framework for the advancement of Indigenous health and reconciliation across the network.

We sat down with Dr. Smylie, who holds a Tier 1 Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada, to learn more about her new role and the challenges Unity Health faces repairing relationships with Indigenous peoples as a Catholic health care network.

What drew you to this role?

Like many people, I was deeply impacted in June 2021 when the first unmarked graves of Indigenous children were confirmed at a residential school in Kamloops, B.C. At the time, I committed to doing three things – helping address the role of the Catholic Church in the residential school system, marking Indigenous History Month at Unity Health and throwing my hat in the ring for this role. As I get older, having worked in health care for some time, I really try to think about the future. What can I do now to make it better? This role gets at that. But most of all, I was really inspired by those children and their families.

This role was designed with the support of Unity Health’s First Nations, Inuit and Métis Community Advisory Panel (CAP) and is intended to be collaborative in nature, working with the Indigenous community in Toronto. Why are these collaborative efforts so important?

Nothing about us without us. In the Canadian Constitution, First Nations, Inuit and Métis peoples are granted the right to live in a way that builds on the continuity of their respective cultural and societal norms. There’s also a domestic and international legal requirement to involve Indigenous peoples in decisions that affect them. It’s also simply more effective to work with the Indigenous community. No one knows what Indigenous people need more than the Indigenous community.

Do you have any specific goals or priorities in your first couple of months in this role?

One of my first priorities is to build a human resources plan for the network. We’ve heard from the First Nations, Inuit and Métis Community Advisory Panel (CAP) and other community leaders that to become a preferred place for Indigenous peoples to seek care, we need to recruit a team of people who can advance transformational change. This might include an Elder, a cultural coordinator, care navigators and a clinical care lead. Indigenous people often expect that they’ll experience differential or unfair treatment when they visit a hospital. We want Unity Health to be a place where Indigenous people feel safe accessing care.

Another priority of mine is building Indigenous care pathways within our hospitals. Defined referral pathways can be really helpful as they provide comfort and build on the notion of trust relationships.

I’ll also be doing some work with the CAP to develop a renewed terms of reference and explore how we can harmonize the efforts of the CAP and Unity Health’s Council on Anti-Racism, Equity and Social Accountability (CARESA). When working with Indigenous communities, it’s important that we establish a leadership structure and governance model to provide clarity and build trust. I’m working on that too.

Many of your research projects and foundational contributions in Indigenous health have relied on data collection. For instance, you co-led Our Health Counts, a collaborative research project that brought to light missing population-based health information on First Nations adults and children in urban settings. Where did this interest in data collection come from and why is it important?

Early in my career, I was working at an Indigenous health centre in Ottawa and we were trying to set up an information system that would help us understand who was coming into the clinic for care. But over time, I started to worry more about the people who don’t come to us or who only come on occasion and then we don’t see them. I wanted a way to identify these people and assess their health needs. I also just really like math. My dad was a theoretical physicist and I’m not afraid to use math as a tool. These factors motivated me to go back to graduate school at Johns Hopkins University. Then, a colleague introduced me to a new type of sampling that works well to count the people who don’t seek care. Everyone deserves to be counted.

Other early work of mine made sure that First Nations, Inuit and Métis identity was accurately recorded on infant birth and death registrations. Infant mortality is a key indicator of the broader population health of a community. We then discovered that the Canadian census was undercounting the size of Indigenous populations in Toronto by a factor of 3 to 5. Identifying that undercount had an immediate benefit, providing a better match between the unmet needs and aspirations for wellbeing of local First Nations, Inuit and Métis communities and the funding and resources made available.

What are some of the biggest barriers to health care for Indigenous peoples in Toronto?

There are approximately 90,000 First Nations, Inuit and Métis peoples living in Toronto and about 90 per cent are living under the low income cut off. Many of these individuals are young people or single caregivers, which can make it difficult to access care. For example, if you need to take the TTC with multiple children in-hand to access care, this makes it much more difficult than if you have a car and childcare. Another barrier, perhaps the biggest one, is a lack of trust in the health care system. There’s a lot of fear among Indigenous peoples that they’ll be treated differently because they’re Indigenous. Some other common barriers are a lack of access to regular primary care providers and not knowing where to seek care. There are also challenges navigating the transportation system.

It’s been nearly two years since Joyce Echaquan, a 37-year-old mother and member of Atikamekw Nation of Manawan, died in a Joliette, Que. hospital after staff dismissed her symptoms and subjected her to racist language and behaviour. A few days later, you co-authored an opinion piece in the Globe and Mail on racism in the medical system. Have we seen any improvements in the system since then?

No. Unfortunately, slow progress with respect to tangible change is a common challenge in systems transformation work – we could ask the same question about anti-Black racism and discrimination towards members of the 2SLGBTQ+ community. We know what works but we don’t have the political will to act on our knowledge. Human beings are funny that way – it’s hard for us to change our minds or act differently.

The Catholic Church was a leader in colonization and ran most of Canada’s residential schools. Unity Health Toronto is one of Canada’s largest catholic health care networks. How does our identity and affiliation with the church change the work we have to do?

First Nations, Inuit and Métis peoples have a complicated relationship with the church because of the role that the church played as a leader in the colonization of the Americas. Every person and community has navigated that relationship in their own way and we respect those ways of navigation. Some people feel safe and happy at Unity Health, while others could be triggered or feel uncomfortable given the legacy of multi-generational harms stemming directly from the policies and actions of the church. We need to figure out how to support that range of responses so that people say “Yes, this is a Catholic hospital but they did something good for my relative.”

Pope Francis is expected to visit Canada in July to meet residential school survivors and deliver an apology on Canadian soil for the church’s role in running residential schools. What does this visit mean to Indigenous peoples?

It’ll mean many different things to different First Nations, Inuit and Métis people. For some survivors of the residential school system and their families, it’ll bring healing and relief from pain. For others, it could bring pain and anger. I think it’s an important step though. If this visit helps anybody, it should happen. Where I come from, restorative justice is important; we need to acknowledge wrongdoing. I hope that’s what this visit represents. It’s what a lot of people wanted and a step in the right direction.

Do you have any advice for those who want to learn more about Indigenous history and culture or who want to help build and repair relationships but are afraid of offending others?

One of the best things people can do is learn more about cultural safety. The San’yas Anti-Racism Indigenous Cultural Safety Training Program, which many staff at Unity Health have completed, has shown to be better than a placebo when measuring how likely Indigenous patients are to recommend someone as a health care provider. I also encourage people to find a peer and read the summary report of the Truth and Reconciliation Commission. It’s painful but we need to be witnesses. It’s also good to attend events celebrating Indigenous people, if the community is willing to share. After the event, spend some time self-reflecting on what it was like to be there. And remember that this is a learning journey.

This interview has been edited and condensed.

By: Anna Wassermann

THE CONVERSATION

Co-written by Dr. Jesse Jenkinson

Visible homelessness during the COVID-19 pandemic has highlighted the housing crisis across Canada. For women, girls and gender-diverse people, homelessness is often hidden, meaning that they are more likely to avoid shelters, couch surf or remain in abusive relationships than end up on the streets. Because of this, we know less about their experiences.

New data from the Pan-Canadian Women’s Housing and Homelessness Survey, the largest gender-specific data collection of its kind in Canada, tells us a clear story.

Lack of access to housing has gendered causes and effects, and gender equality in Canada depends on fair access to adequate housing. This survey, completed by 500 women and gender-diverse people in 12 provinces and territories, shows us why housing is a women’s rights issue.

TORONTO STAR

By Tara Kiran, Noah Ivers, Sabina Vohra-Miller

We all want the pandemic to be over. Last week, that dream came closer to reality.

Pfizer released a statement showing an effective and safe vaccine in children aged 5 to 11. Pfizer will soon submit the full data package to Health Canada and If the data is considered sufficient, and no concerns are identified, the vaccine could be approved for this age group as early as Halloween.

A COVID-19 vaccine for children is a game-changer. It not only protects our kids from getting COVID-19 and its related complications, it also protects their loved ones and the wider community. It will limit transmission of the virus—preventing classes from being sent home, allowing a return to sports and other activities, and reduces the risk of unknowingly passing the virus on to someone more vulnerable like a grandparent.

But the vaccine only works if people get it.

We must work quickly to get the largest number of kids vaccinated as fast as possible—and ensure an equitable roll-out prioritizing those most at-risk. The most efficient and effective way to do so is by bringing vaccines to schools.

Lire cet article en français

UNITY HEALTH TORONTO

A new paper published by Unity Health Toronto researchers found most adults experiencing homelessness have faced an incredible burden of childhood trauma.

The paper, published in Lancet Public Health, found nine in 10 homeless adults have been exposed to at least one adverse childhood experience and over half have been exposed to four or more adverse childhood experiences. Previous research in the general population has shown that those exposed to four or more childhood traumas were 17 times more likely to have attempted suicide than those who had not experienced trauma in childhood.

Michael Liu, lead author of the study, is a research coordinator at St. Michael’s MAP Centre for Urban Health Solutions, a medical student at Harvard University and a Rhodes Scholar. We spoke with Michael, a Toronto native, about the systematic review and meta-analysis and why he says services must be trauma-informed and there must be a greater emphasis on early-intervention.

The paper sought to answer the question: how often have adults experiencing homelessness had an adverse childhood experience? Why is this important to investigate?

There’s lots of literature on adverse childhood experiences in the general public, but I think this is a really under-appreciated aspect of homelessness. Adverse childhood experiences encompass potentially traumatic events occurring before the age of 18 years, such as abuse, neglect, and household dysfunction.

In the late 1990s, studies showed us that early trauma affects health throughout one’s entire life course. The accumulation of toxic stress affects just about everything – from our mental health to chronic disease. We know that toxic stress can lead to disrupted brain development, with long-term consequences for learning, behaviour, and broad social outcomes. So we wanted to understand how big of a problem is early trauma in the homeless population, and if it is, what can we do about it? What do policymakers need to know?

Selon une méta-analyse, 90 % des adultes vivant en situation d’itinérance ont subi un traumatisme pendant leur enfance

Un nouvel article publié par des chercheurs de Unity Health Toronto a révélé que la plupart des adultes sans domicile fixe ont subi de lourds traumatismes pendant leur enfance.

L’article, publié dans la revue Lancet Public Health, a révélé que neuf adultes sans domicile fixe sur dix ont été exposés à au moins une expérience négative dans leur enfance, tandis que plus de la moitié ont été exposés à quatre expériences négatives ou plus. Des recherches antérieures menées auprès de la population générale ont montré que les personnes exposées à quatre traumatismes ou plus durant l’enfance étaient 17 fois plus susceptibles de faire une tentative de suicide que celles qui n’avaient pas subi de traumatisme à cette époque.

Auteur principal de l’étude, Michael Liu est coordonnateur de recherche au Centre MAP pour des solutions de santé urbaine de l’hôpital St. Michael, étudiant en médecine à l’Université Harvard et boursier Rhodes. Nous avons discuté avec Michael, originaire de Toronto, de l’examen systématique et de la méta-analyse ainsi que des raisons pour lesquelles il estime que les services doivent tenir compte des traumatismes et insister davantage sur l’intervention précoce.

Lire cet article en français

HEALTHY DEBATE

By Zoë Dodd, Samantha Young, Lisa Boucher, Abeera Shahid, Melanie Brown, Kimia Khoee, and Ahmed Bayoumi

While people have been living in encampments for decades, they have never been as visible as during the COVID-19 pandemic. The City of Toronto has also been dismantling encampments for a long time – more than 700 were dismantled in 2019 – but never as forcefully as this year. Yet, in all of the discussions about how politicians, police and city workers should respond to encampments, there has been little effort to understand why encampments exist and what they mean to people living in them.

As researchers at MAP Centre for Urban Health Solutions at Unity Health Toronto, we have been studying outreach services provided to people who live in encampments. As part of a large study of the effects of the response to the COVID-19 pandemic on people experiencing marginalization, we surveyed 127 residents of Toronto’s Trinity Bellwoods, Alexandra Park, Lamport Stadium, Moss Park, Cherry Beach and Sanctuary encampments between March and June 2021 (and before the most recent evictions in July 2021). While our full report will be released in October, we believe it pertinent to release these preliminary findings to add to the current conversation on encampment evictions.

Overall, our findings suggest that the story of encampments is complex. Five results of our survey are especially important and may contradict commonly held assumptions.

La vie dans les campements est bien plus qu’un simple problème lié à la pandémie, selon des chercheurs

Par Zoë Dodd, Samantha Young, Lisa Boucher, Abeera Shahid, Melanie Brown, Kimia Khoee et Ahmed Bayoumi

Bien que des gens vivent dans des campements depuis des décennies, ils n’ont jamais été aussi en évidence que pendant la pandémie de COVID-19. La Ville de Toronto démantèle depuis des années des campements (plus de 700 l’ont été en 2019), mais jamais d’une façon aussi énergique que cette année. Malgré toutes les discussions sur la façon dont les politiciens, la police et les employés municipaux devraient réagir à la présence de campements, peu d’efforts ont été faits pour comprendre la raison d’être de ces derniers et ce qu’ils signifient pour les personnes qui y vivent.

En tant que chercheurs du Centre MAP pour des solutions de santé urbaine de Unity Health Toronto, nous avons étudié les services de proximité fournis aux personnes qui vivent dans des campements. Dans le cadre d’une vaste étude sur les effets des mesures liées à la pandémie de COVID-19 sur les personnes en situation de marginalisation, nous avons interrogé 127 résidents des campements de Trinity Bellwoods, d’Alexandra Park, du Lamport Stadium, de Moss Park, de Cherry Beach et de Sanctuary à Toronto entre mars et juin 2021 (et avant les expulsions les plus récentes en juillet 2021). Notre rapport complet sera publié en octobre, mais nous pensons qu’il est pertinent de diffuser ces conclusions préliminaires pour enrichir le débat actuel portant sur le phénomène des expulsions de campements. Dans l’ensemble, nos résultats suggèrent que le dossier des campements est complexe. Cinq résultats de notre enquête sont particulièrement importants et sont susceptibles de démentir des hypothèses largement répandues.

September 28, 2021                               

Re: Planning and Housing Committee Item PH25.10 – New Regulatory Framework for Multi-Tenant Houses

We would like to acknowledge this matter was brought to our attention by individuals with lived experience in Multi-Tenant Houses who have raised this as an area of community priority.

We are health care providers, scientists and researchers who work in association with MAP Centre for Urban Health Solutions at St. Michael’s Hospital. We live in all areas of the city, and are united in our concern about the lack of good quality, permanent and deeply affordable housing in Toronto. We are pleased that the City of Toronto has put forth a framework to permit and regulate Multi-Tenant Houses across the city, and we expect the Mayor and Councillors who represent us to support this framework. We are calling on our Mayor and City Councillors to support the motion to regulate Multi-Tenant Houses across Toronto at the October 1^st, 2021 session of City Council. We will be contacting our Councillors about this motion, and encouraging our co-workers, neighbours and community to do the same.

Multi-Tenant Houses (MTH), also known as rooming houses, have long been part of Toronto’s housing structure and make a significant contribution to the limited affordable housing stock in our city. A diverse cross-section of people rely on this housing stock, including people with lower incomes, students, recent immigrants, migrant workers, and people with disabilities.

In 1998, the provincial government amalgamated six municipalities to create the new “mega city” of Toronto. While MTH had been legally permitted in some of these municipalities, such as the old city of Toronto, they were not permitted in the former cities of North York, East York and Scarborough. More than 20 years later, Toronto has still not harmonized by-laws across the city, and MTH are still not technically allowed to exist in some areas.

This doesn’t mean they don’t exist—they do and always have. Instead, it means that tenants living in unregulated and unlicensed MTH have fewer options to protect their health and safety. This has ripple effects for the surrounding communities, which are much safer when MTH are regulated.

According to City of Toronto data, licensed MTH are far safer than unlicensed MTH. For instance, between the years 2010 to 2020, there were 18 MTH that were involved in fire fatalities and serious injuries, 16 of which were unlicensed. Additionally, the vast majority of MTH charges laid by Municipal Licensing & Standards are in neighbourhoods where they are not permitted. The Maytree Foundation’s human rights review of  Toronto’s MTH policies also reported that individuals living in MTH in unpermitted areas are less likely to report substandard conditions and, therefore, live at greater risk of harm to their health and personal safety. Unpermitted houses are also more likely to violate existing regulations (i.e., the Ontario Building Code).

As health care providers and researchers, we see the impacts of sub-standard housing and housing instability on wellbeing, and on mental and physical health. We also know that when someone loses their housing, it has adverse consequences for their lives, families and communities. For instance, research suggests that when people experience involuntary loss of housing, they are more likely to also lose their job. We know that MTH often provides the only affordable option in the private housing market, and can potentially help people avoid homelessness.

Research on permitted MTH has shown that people of lower socioeconomic background and with existing health conditions have often resided in houses that are in poor physical condition. This is likely even worse for houses that are unpermitted. Good housing quality is critical for health—factors such as adequate space allocation, indoor air quality and proper waste and pest management are essential for disease prevention, especially in congregate living settings.  Permitting and regulating MTH in unpermitted areas will create a means for the City to enforce quality standards across the City, which will ultimately benefit both tenants and surrounding communities.

The City staff report notes that the proposed framework will aim to take a phased approach that will include education and outreach to tenants on their rights, as well as support for landlords to meet property standards. We applaud the City for including this in their plan as it can help sustain existing MTH and provide opportunities to invest in improving this affordable housing stock.

From our vantage point within the health care sector, we would also like to share the following recommendations with City Council:

1. Establish equitable support services to help MTH tenants retain their housing and assist qualifying landlords retain their homeownership once their area of the city is regulated. This could be achieved through collaboration with community agencies as well as establishing grant programs.
2. Ensure that enforcement of the new regulations does not further harm and marginalize groups who are likely to live in MTH —this will be key to meeting the City’s human rights approach.
3. At implementation, continue to engage in the multi-divisional cross collaboration (Fire Services; Toronto Building, Municipal Licensing & Standards; City Planning; Toronto Public Health) that was used to develop the new framework.  This collaboration will contribute to the development of a more robust policy practice in relation to housing, health and community safety. 

Ultimately, a harmonized MTH regulation can help improve current policy and practices and will allow for this affordable housing stock to be better integrated within our housing continuum.

We commend the City for taking steps to solving this long standing equity issue in our city. We encourage the City to continue to consult the community in finding ways to sustain and strengthen the quality of this affordable housing stock and ask the Mayor and City Council to support the regulation of MTH across Toronto at the upcoming Council meeting. This will align with the City’s commitment to advance a human rights based approach to housing as outlined in Housing TO 2020-2030 Action Plan.

What You Can Do

Call Your City Councillor and the Mayor: Members of Council Contact Information

Sign Community petition: The Federation of Metro Tenants’ Associations (FMTA)

Take the ACTO and CERA survey on Multi-Tenant Housing: Survey  

Find More Information

City of Toronto: Multi-Tenant (Rooming) Houses Maytree Foundation: A Human Rights Review of Toronto’s Multi-Tenant Homes Policies

Signed by health care providers, scientists and researchers who work in association with MAP Centre for Urban Health Solutions at St. Michael’s Hospital:

1. Stephen Hwang, Director, MAP Centre for Urban Health Solutions, Unity Health Toronto
2. Ann Burchell, Scientist
3. Andrew Pinto, Scientist and Physician
4. Jesse Jenkinson, Postdoctoral Research Fellow
5. Uzma Ahmed, Research Coordinator
6. Galo F. Ginocchio, Research Coordinator
7. Olivia Spandier, Research Coordinator
8. Y. Celia Huang, Research Coordinator
9. Ashley Mah, Research Co-ordinator
10. Triti Khorasheh, Research Coordinator
11. Madison Ford, Research Coordinator
12. Anaita Kharwanwala, Administrative Assistant
13. Anna Yeung, Research Manager
14. Nav Persaud, Scientist, Family Physician, Canada Research Chair in Health Justice
15. Flora Matheson, Scientist
16. Ruby Sniderman, Research Manager
17. Kimberly Devotta, Research Manager
18. Alexandra Carasco, Research Coordinator
19. Evie Gogosis, Research Manager
20. Aine Workentin, Research Coordinator
21. James Watson, Research Manager
22. Andree Schuler, Research Associate
23. Ahmed Bayoumi, Fondation Baxter and Alma Ricard Chair in Inner City Health, MAP Centre for Urban Health Solutions, Unity Health Toronto
24. Fred Ellerington, Homeless Outreach Counsellor
25. Zoe Dodd, MES, Community Scholar
26. Vera Dounaevskaia , MD
27. Rosane Nisenbaum, Biostatistician
28. Dr. James Rassos, GIM Staff Physician
29. Jessica Demeria, Indigenous research coordinator
30. Sharmistha Mishra, Infectious Disease Physician and Associate Professor, University of Toronto
31. Anne-Marie Tynan, Research Program Manager
32. Jemal Demeke, Research Coordinator
33. Mackenzie Hamilton, Junior Data Science Specialist
34. Kate Francombe Pridham, Research Program Manager, Homelessness, Housing, and Health
35. Ketan Shankardass, Affiliate Scientist
36. Cheryl Rowe, Community Psychiatrist
37. Stefan Baral, Family and Population Health Physician, Inner City Health Associates
38. Suzanne Shoush, Graduate student, Staff Physician, St. Michael’s Unity Health
39. Ayan Yusuf, Research Coordinator
40. James Kitchens, Staff Physician, St. Michael’s Hospital
41. Nazlee Maghsoudi, Research Manager
42. Angela Onkay Ho, Psychiatrist
43. Mara Waters, Internal medicine resident
44. Tracy Rook, Registered Nurse
45. Melissa Capozzolo, Registered Practical Nurse
46. Shazeen Suleman, Investigator
47. Aaron Orkin, Physician
48. Nigel Champion, Resident Doctor
49. Emily Holton, Communications Manager
50. İrem Burcu Baltaş, Registered Nurse
51. Gillian Kennedy, Registered Nurse
52. Michelle Catchpole, Research Business Analyst
53. Charles Ozzoude, Researcher
54. Roisin McElroy, MD CCFP(EM)
55. John Ecker, Research Manager
56. Brooke Fraser , Internal medicine resident – PGY2 
57. Carol Munroe, Medical Admin Administrator
58. Erica Di Ruggiero, Associate Professor
59. Kristy Yiu, Research Coordinator
60. Peter Gozdyra, Visiting Researcher
61. Naheed Dosani, Lecturer, Department of Family & Community Medicine, University of Toronto
62. Madeleine Ritts, Social worker
63. Suzanne Zerger, Research Program Manager
64. Billie-Jo Hardy, Scientist, WIHV, Women’s College Hospital
65. David Reycraft , Director – Housing Services Dixon Hall Neighbourhood Services
66. Sara Pickersgill, MD
67. Andrea A. Cortinois, Assistant Professor, University of Toronto
68. Deborah Pink, Physician
69. Asha Aggarwal, Social Worker
70. Paul Zijlstra, Registered Practical Nurse
71. Lisa Forman, Associate Professor, Dalla Lana School of Public Health, University of Toronto
72. James Lachaud, Postdoctoral researcher
73. Luke Hays, Emergency Doctor
74. Darryl Langendoen, Social Worker
75. Opal Sparks, Advocate
76. Rene Adams, Community Expert
77. Samantha Green, Family Physician, Inner City Health Associates and Unity Health Toronto
78. Maryam Daneshvarfard, Research Coordinator
79. Carol Strike, Professor/Scientist
80. Heather McLean, Research Assistant I
81. Emilie Frenette, NP-PHC
82. George Da Silva, Person who was homeless (Peer Research Assistant)
83. Jesse Knight, PhD Candidate
84. Veronica Snooks, Community Expert Group member, Dream team member, PWLE caucas member
85. Terry Pariseau, Coordinated Access Engagement Coordinator
86. Denise Gastaldo, Associate Professor, University of Toronto
87. Sa’ad Talia , Community Expert Group Research Consultant
88. Veronica van Dam, Nurse practitioner
89. Gary Bloch, Family Physician; Associate Professor, University of Toronto
90. Elizabeth Harrison, Registered Nurse
91. Adam Suleman, Resident Physician
92. Daniela Mergarten, Co-Chair of the lived experience caucus of the Toronto Alliance to End Homelessness
93. Pearl Buhariwala, Research Coordinator
94. Yue Chen, Junior Data Scientist
95. Nicole Champagne, Social Worker
96. Kira Heineck, Executive Director, Toronto Alliance to End Homelessness
97. Chan Drepaul, Program Manager
98. Dr Laura Pacione, Child and Adolescent Psychiatrist
99. Drew Silverthorn, Community Mental Health Social Worker
100. Arthur McLuhan, Postdoctoral Research Fellow
101. Amy Katz , Knowledge Translation Specialist
102. Kim Chamberland, Registered Nurse
103. Bee Lee Soh, Community Expert Group member
104. Dr. Farah N. Mawani, Postdoctoral Fellow
105. Vikram Jayanth Ramalingam Research Assistant
106. Reena Pattani, Physician
107. John Sollazzo, Emergency Physician
108. Alyssa Ranieri, Homeless Outreach Counsellor
109. Christina HW Kim, Resident Physician
110. Wale Ajiboye, Senior Research Associate
111. Philip Garwood, Resident Doctor

THE CONVERSATION

By Drs. Stephen Hwang and Jesse Jenkinson

The number of people visibly living in encampments has increased throughout the COVID-19 pandemic. This has led to cities — including Toronto, Victoria and Vancouver — to work with encampment residents to move them into shelters, hotel spaces and more rarely, stable housing.

When those offers are declined, the next step can be the removal of residents’ belongings, and sometimes — such as recent events in Toronto and Halifax — violent evictions by police.

As researchers who work to improve the health and well-being of people who experience of homelessness, we are deeply concerned about the long-term consequences of this approach. Not only is it morally questionable to punish the most vulnerable, it isn’t an effective strategy for addressing homelessness. Criminalizing poverty doesn’t work.

The first step in addressing this problem is understanding the answer to this basic question: Why are some people in encampments insisting on staying where they are?

Lire cet article en français

From the Toronto Star article:

…Some schools are also being supported by external programs, like the Model Schools Pediatric Health Initiative run out of St. Michael’s Hospital in Toronto and Unity Health, which serves over 50 inner city schools through clinics based in Sprucecourt Public School and Nelson Mandela Park Public School. Dr. Sloane Freeman, a pediatrician and lead of the clinics, said she anticipates “a storm of referrals” as schools reopen for in-school learning.

“It’s very difficult to identify kids’ needs virtually, whether it be educational needs, mental health needs or developmental health needs,” Freeman said, adding that features of ADHD and autism, for example, are much harder to pick up on through a screen.

Freeman said she anticipates some children returning to the classroom will display symptoms of anxiety and depressed moods, but also problems with emotional outbursts. “We’ve always seen challenges with kids’ self-regulation and having a hard time managing big emotions, and I think we’re going to see more of that.”

Les écoles se préparent à une hausse de la demande de services en santé mentale avec la reprise des cours en présentiel

Extrait de l’article du Toronto Star :

… Certaines écoles sont également soutenues par des programmes extérieurs, comme le Model Schools Pediatric Health Initiative de l’hôpital St. Michael de Toronto et Unity Health, qui dessert plus de 50 écoles du centre-ville avec ses cliniques établies dans les écoles publiques Sprucecourt et Nelson Mandela Park. La docteure Sloane Freeman, pédiatre et responsable des cliniques a déclaré qu’elle s’attendait à une « foule de demandes de consultation » avec la réouverture des cours en présentiel.

« Il est très difficile de définir les besoins des enfants de manière virtuelle, que ce soit en matière d’éducation, de santé mentale ou de santé développementale », a déclaré la D^re Freeman, ajoutant que les particularités du TDAH et de l’autisme, par exemple, sont beaucoup plus difficiles à déceler à travers un écran. La D^re Freeman a déclaré s’attendre à ce que certains enfants retournant en classe présentent des symptômes d’anxiété et d’humeur dépressive, mais aussi des problèmes de débordements émotionnels. « Les défis liés à l’autorégulation chez les enfants et à la difficulté de gérer les émotions fortes ont toujours été présents, et je pense que nous en verrons davantage. »

THE GLOBE AND MAIL

By Sloane Freeman and Ripudaman Singh Minhas

When schools reopen in September, they will need to answer difficult questions in the face of ongoing challenges from COVID-19. And in doing so, they will also need to take into account that the pandemic affected school-aged children in different ways.

The duration of school closures varied across provinces and territories – Ontario, for instance, experienced the longest shutdown at 26 weeks. How will that varied length affect children in different areas? It is anticipated that Canadian students will return to school this fall with greater mental and physical health needs, as well as significant learning gaps – but children facing socioeconomic instability have been most affected. How will schools be equipped and resourced to support returning students’ additional needs? Similarly, will schools have the capacity to meet the learning needs of students who have fallen substantially behind?